Customer SS

New Customer Service Application

Please complete all required questions in the following form. Upon submitting your request a Customer Service Representative will review the request. Submitting this form does not mean the request have been granted or resolved.

Please select your address using the search field below.

Search Service Address

This field is required.

Location search requires a minimum of 4 characters.
For example 1234 Main Street Apt 23,

Address to move into

This field is required.

Effective Date of Service Connection

This field is required.

Mailing Address

Enter New Address

Have you ever had utility service before before?

Yes No

This field is required.

Are you an Owner or a Tenant of the property

This field is required.

Primary Applicant Information

Note: Please enter your name exactly as it appears on your identification. If you are a company place your company's name in the last name field.

First Name

Middle Name

Last Name / Company Name

This field is required.

Primary Phone Number

This field is required.

Extension

Secondary Phone Number

Extension

Email Address

This field is required.

Confirm Email Address

Email address must match

Last 4 digits of your SSN

This field is required.

Drivers License Number

Drivers License State

I have read and agree to the Terms and Conditions.

This field is required.

Cancel